Assessment of Low Back Pain: Reliability and Minimal Detectable Change of the Brief Pain Inventory.

IMPORTANCE: The Brief Pain Inventory (BPI) is one of the most widely used measures to assess pain and related impacts among patients with low back pain (LBP). However, its test-retest reliability and minimal detectable change (MDC) have rarely been examined in patients with LBP, interfering with its utility. OBJECTIVE: To investigate the test-retest reliability and MDC of the BPI among patients with LBP. DESIGN: Repeated assessments design with a 1-wk interval. SETTING: Department of Physical Medicine and Rehabilitation in a hospital in Taiwan. PARTICIPANTS: Fifty-four patients with stable LBP conditions. OUTCOMES AND MEASURES: The BPI has two subscales-Intensity and Interference-that assess pain intensity and pain interference, respectively. Their test-retest reliability was examined using the intraclass correlation coefficient (ICC), and MDCs were calculated. RESULTS: The ICCs of the Intensity and Interference subscales were .62 and .76, respectively. The MDC values for the two subscales were 2.57 and 2.34, respectively. For the four Intensity items, the average-pain score had a higher ICC (.60) than scores on the other items (worst, least, and current pain, which had ICCs of about .40). CONCLUSIONS AND RELEVANCE: The results suggest that although the BPI is a commonly used measure of pain intensity and pain interference among patients with LBP, caution should be exercised in interpreting the Intensity subscale score and its item scores. What This Article Adds: The BPI is widely used to assess pain and related impacts on daily occupation and functioning among patients with LBP. This study provides information regarding its test-retest reliability. Moreover, the MDC values provide clinicians and researchers with the thresholds for determining real improvement (beyond random measurement error).

Activation of multiple proteolysis systems contributes to acute cadmium cytotoxicity.

Cadmium exhibits both toxic and carcinogenic effects, and its cytotoxicity is linked to various cellular pathways, such as oxidative stress, ubiquitin-proteasome, and p53-mediated response pathways. The molecular mechanism(s) underlying cadmium cytotoxicity appears to be complex, but remains largely unclear. Here, we examined the effects of cadmium on the protein catabolism using two surrogate markers, DNA topoisomerases I and II alpha and its contribution to cytotoxicity. We have found that cadmium exposure induced time- and concentration-dependent decreases in the protein level of surrogate markers and therefore suggest that cadmium may be involved in proteolysis system activation. A pharmacological study further revealed the novel role(s) of these proteolytic activities and reactive oxygen species (ROS) in the cadmium-induced acute toxicity: (i) Proteasome inhibition only partially relieved the cadmium-induced proteolysis of topoisomerases; (ii) Moreover, we report for the first time that the activation of metalloproteases, serine proteases, and cysteine proteases contributes to the acute cadmium cytotoxicity; (iii) Consistent with the notion that both ROS generation and proteolysis system activation contribute to the cadmium-induced proteolysis and cytotoxicity, the scavenger N-acetylcysteine and aforementioned protease inhibition not only reduced the cadmium-induced topoisomerase degradation but also alleviated the cadmium-induced cell killing. Taken together, acute cadmium exposure may activate multiple proteolytic systems and ROS formation, subsequently leading to intracellular damage and cytotoxicity. Thus, our results provide a novel insight into potential action mechanism(s) by which cadmium exerts its cytotoxic effect and suggest potential strategies to prevent cadmium-associated acute toxicity.

The determinants of motorized mobility scooter driving ability after a stroke.

PURPOSE: To investigate the determinants related to the ability to drive a motorized mobility scooter after a stroke. METHOD: The study was a cross-sectional study. The ability to drive a motorized mobility scooter was measured with the Power Mobility Clinical Driving Assessment. The independent variables included cognitive functions measured by the Color Trails Test and reaction time test, visual functions measured by a visual acuity test and visual field test, and motor functions measured with a dynamometer, the Box and Block Test, and the Functional Independence Measure. RESULTS: The correlation analyses revealed that the Power Mobility Clinical Driving Assessment scores had significant correlations with reaction time (ρ = -.65, p < 0.01), binocular visual field (r = .64, p < 0.01), binocular visual acuity (r = .40, p = 0.03), and the grip strength of the unaffected hand (r = .47, p = 0.01). The multiple regression analysis indicated that reaction time, binocular visual field, and the grip strength of the unaffected hand were the most significant determinants of the ability to drive a motorized mobility scooter (R2 = .76). CONCLUSIONS: The reaction time, binocular visual field, and grip strength of the unaffected hand were the most significant determinants related to the ability to drive a motorized mobility scooter after a stroke. IMPLICATIONS FOR REHABILITATIONMotorized mobility scooter driving ability for stroke patients is correlated with demographics (age, mobility scooter driving experience, time since last drive) and cognitive, visual and motor functions (reaction time, binocular visual field, visual acuity, and the grip strength of unaffected hand).Primary determinants of motorized mobility scooter driving ability for stroke patients include reaction time, binocular visual field, and grip strength of the unaffected hand.Comprehensive assessments incorporating cognitive, visual and motor functions are needed to evaluate the ability to drive a motorized mobility scooter after a stroke.

Inflammatory interferon activates HIF-1α-mediated epithelial-to-mesenchymal transition via PI3K/AKT/mTOR pathway.

BACKGROUND: Tumor microenvironments (TMEs) activate various axes/pathways, predominantly inflammatory and hypoxic responses, impact tumorigenesis, metastasis and therapeutic resistance significantly. Although molecular pathways of individual TME are extensively studied, evidence showing interaction and crosstalk between hypoxia and inflammation remain unclear. Thus, we examined whether interferon (IFN) could modulate both inflammatory and hypoxic responses under normoxia and its relation with cancer development. METHODS: IFN was used to induce inflammation response and HIF-1α expression in various cancer cell lines. Corresponding signaling pathways were then analyzed by a combination of pharmacological inhibitors, immunoblotting, GST-Raf pull-down assays, dominant-negative and short-hairpin RNA-mediated knockdown approaches. Specifically, roles of functional HIF-1α in the IFN-induced epithelial-mesenchymal transition (EMT) and other tumorigenic propensities were examined by knockdown, pharmacological inhibition, luciferase reporter, clonogenic, anchorage-independent growth, wound-healing, vasculogenic mimicry, invasion and sphere-formation assays as well as cellular morphology observation. RESULTS: We showed for the first time that IFN induced functional HIF-1α expression in a time- and dose- dependent manner in various cancer cell lines under both hypoxic and normoxic conditions, and then leading to an activated HIF-1α pathway in an IFN-mediated pro-inflammatory TME. IFN regulates anti-apoptosis activity, cellular metastasis, EMT and vasculogenic mimicry by a novel mechanism through mainly the activation of PI3K/AKT/mTOR axis. Subsequently, pharmacological and genetic modulations of HIF-1α, JAK, PI3K/AKT/mTOR or p38 pathways efficiently abrogate above IFN-induced tumorigenic propensities. Moreover, HIF-1α is required for the IFN-induced invasiveness, tumorigenesis and vasculogenic mimicry. Further supports for the HIF-1α-dependent tumorigenesis were obtained from results of xenograft mouse model and sphere-formation assay. CONCLUSIONS: Our mechanistic study showed an induction of HIF-1α and EMT ability in an IFN-mediated inflammatory TME and thus demonstrating a novel interaction between inflammatory and hypoxic TMEs. Moreover, targeting HIF-1α may be a potential target for inhibiting tumor tumorigenesis and EMT by decreasing cancer cells wound healing and anchorage-independent colony growth. Our results also lead to rationale guidance for developing new therapeutic strategies to prevent relapse via targeting TME-providing IFN signaling and HIF-1α programming.

Fuzzy logic-based mobile computing system for hand rehabilitation after neurological injury.

BACKGROUND: Effective neurological rehabilitation requires long term assessment and treatment. The rapid progress of virtual reality-based assistive technologies and tele-rehabilitation has increased the potential for self-rehabilitation of various neurological injuries under clinical supervision. OBJECTIVE: The objective of this study was to develop a fuzzy inference mechanism for a smart mobile computing system designed to support in-home rehabilitation of patients with neurological injury in the hand by providing an objective means of self-assessment. METHODS: A commercially available tablet computer equipped with a Bluetooth motion sensor was integrated in a splint to obtain a smart assistive device for collecting hand motion data, including writing performance and the corresponding grasp force. A virtual reality game was also embedded in the smart splint to support hand rehabilitation. Quantitative data obtained during the rehabilitation process were modeled by fuzzy logic. Finally, the improvement in hand function was quantified with a fuzzy rule database of expert opinion and experience. RESULTS: Experiments in chronic stroke patients showed that the proposed system is applicable for supporting in-home hand rehabilitation. CONCLUSIONS: The proposed virtual reality system can be customized for specific therapeutic purposes. Commercial development of the system could immediately provide stroke patients with an effective in-home rehabilitation therapy for improving hand problems.

Synthetic nickel-containing superoxide dismutase attenuates para-phenylenediamine-induced bladder dysfunction in rats.

Para (p)-phenylenediamine and its toxic metabolites induce excess reactive oxygen species formation that results in bladder voiding dysfunction. We determined the effects of synthetic Ni-containing superoxide dismutase mimics and the role of oxidative stress in p-phenylenediamine-induced urinary bladder dysfunction. P-phenylenediamine (60 µg/kg/day) was intraperitoneally administered for 4 weeks to induce bladder injury in female Wistar rats. Synthetic Ni-containing superoxide dismutase mimics, WCT003 (1.5 mg/kg) and WCT006 (1.5 mg/kg), were then intraperitoneally administered for 2 weeks. Transcystometrograms were performed in urethane-anesthetized rats. The in vitro and in vivo reactive oxygen species levels and pathological changes in formalin-fixed bladder sections were evaluated. Western blotting and immunohistochemistry elucidated the pathophysiological mechanisms of oxidative stress-induced apoptosis, autophagy, and pyroptosis. P-phenylenediamine increased voiding frequency, blood and urinary bladder levels of reactive oxygen species, and neutrophil and mast cell infiltration. It also upregulated biomarkers of autophagy (LC3 II), apoptosis (poly (ADP-ribose) polymerase), and pyroptosis (Caspase 1). WCT003 and WCT006 ameliorated reactive oxygen species production, inflammation, apoptosis, autophagy, pyroptosis, and bladder hyperactivity. P-phenylenediamine increased oxidative stress, inflammatory leukocytosis, autophagy, apoptosis, and pyroptosis formation within the urinary bladder. Novel synthetic nickel-containing superoxide dismutase mimics relieved p-phenylenediamine-induced bladder inflammation and voiding dysfunction.

The efficacy of ultrasound-guided extracorporeal shockwave therapy in patients with cervical spondylosis and nuchal ligament calcification.

We investigated the effects of extracorporeal shockwave therapy (ESWT) on the rehabilitation of cervical spondylosis with nuchal ligament (NL) calcification under X-ray and ultrasound guidance. Sixty patients with cervical spondylosis and calcification of NL were selected and randomly assigned to three groups: A, B, and C. Patients in Group A received rehabilitation with 20 minutes of hot packs and underwent 15 minutes of intermittent cervical traction three times/week for 6 weeks. Patients in Group B received the same rehabilitation as those in Group A and ESWT (2000 impulses, 0.27 mJ/mm(2)) over the calcified NL guided by X-ray image. Patients in Group C received the same treatment as those in Group B, but the ESWT was guided by musculoskeletal sonography. The therapeutic effects were evaluated by: changes in range of motion (ROM) of the cervical spine including flexion, extension, lateral bending, and rotation; visual analog pain scale; and Neck Disability Index before and after treatment and at follow up 3 months later. We found a significant reduction in pain in each treated group after treatment and at follow up. However, patients in Groups B and C showed more improvements in ROM and neck pain relief after treatment and a decrease in Neck Disability Index. Furthermore, patients in Group C showed better cervical ROM at follow up than Group B. ESWT is an adjuvant treatment in the management of cervical spondylosis with calcification of NL and ultrasound-guided ESWT results in more functional improvements.

Association between the severity of femoral condylar cartilage erosion related to knee osteoarthritis by ultrasonographic evaluation and the clinical symptoms and functions.

OBJECTIVE: To determine the association between the severity of femoral condylar cartilage erosion resulting from knee osteoarthritis (OA) by an ultrasonographic grading system and the clinical symptoms and functions. DESIGN: Cross-sectional study. SETTING: A tertiary center. PARTICIPANTS: Participants (N=101) with and without subjective complaints of knee discomfort were consecutively enrolled. Patients who had ever received knee arthroplasty, who had inflammatory arthritis, and whose knee flexion range of motion was <90° were excluded. A total of 194 knees were evaluated. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A semiquantitative ultrasonographic grading system was used to evaluate the severity of femoral condylar cartilage erosion. The clinical symptoms and functions were evaluated with the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne index. The association of the VAS/WOMAC/Lequesne index with the ultrasonographic grading was assessed. RESULTS: Positive linear associations were found between the ultrasonographic grading and the following: the VAS and the total scores and pain subscales of both the Lequesne index and WOMAC. Multivariate logistic regression analysis revealed grade-dependent association between VAS and ultrasonographic grading after adjusting for age, sex, and body mass index. The WOMAC and Lequesne index scores were associated with the ultrasonographic grading in more severe degrees, particularly in the pain subscales. CONCLUSIONS: This semiquantitative ultrasonographic grading system may well reflect the clinical symptoms and functions related to knee OA as evaluated by the VAS, WOMAC, and Lequesne index. This method provides a more comprehensive description and measurement of knee OA.

The efficacy of shock wave therapy in patients with knee osteoarthritis and popliteal cyamella.

This randomized, controlled study was performed to compare the effects of extracorporeal shockwave therapy (ESWT) and ultrasound on the rehabilitation of knee osteoarthritis with popliteal cyamella. One hundred and twenty patients with bilateral moderate knee osteoarthritis (Altman III) and popliteal cyamella were selected and randomly assigned to four groups (GI-GIV). Patients in Groups I-III received isokinetic muscular strengthening exercises three times weekly for 8 weeks. Group II received pulse ultrasound treatment for popliteal cyamella three times weekly for 8 weeks, Group III received weekly shock wave therapy for popliteal cyamella for the first 6 weeks, and Group IV acted as controls. The therapeutic effects were evaluated by changes in the arthritic knees range of motion (ROM), visual analogue scale, Lequesne's index, and muscle peak torques after treatment and at follow-up 6 months later. Each treated group exhibited increased muscle peak torques and significantly reduced pain and disability after treatment and at follow-ups. However, only patients in Groups II and III showed significant improvements in ROM after treatment, and only participants in Group III showed immediate improvement in ROM after each treatment. Patients in Group III also showed the greatest increase in muscular strength and the greatest decrease in disability after treatment and at the follow-ups. ESWT is better than pulse ultrasound in rehabilitation of patients with knee osteoarthritis and popliteal cyamella results in more functional improvements.

Oxygen uptake response to cycle ergometry in post-acute stroke patients with different severity of hemiparesis.

This study evaluated the impact of severity of hemiparesis on oxygen uptake (VO2) response in post-acute stroke patients. Sixty-four patients with a mean poststroke interval of 8.6 ± 3.8 days underwent a ramp cardiopulmonary exercise test on a cycling ergometer to volitional termination. Mean peak VO2 (VO2peak) and work efficiency (ΔVO2/ΔWR) were measured by open-circuit spirometry during standard upright ergometer cycling. Severity of the hemiparetic lower limb was assessed by Brunnstrom's motor recovery stages lower extremity (BMRSL). VO2peak was 10% lower in hemiparetic leg with BMRSL V than in that with BMRSL VI, 20% lower in BMRSL IV, and 50% lower in BMRSL III. ΔVO2/ΔWR was higher for the group with increased BMRSL. The relations were consistent after adjustment for age, sex, body mass index, stroke type, hemiparetic side, modified Ashworth Scale, time poststroke, comorbidities, and medications. Our findings revealed that O2peak is dependent on the severity of hemiparesis in leg, and along with ΔO2/ΔWR closely related to the severity of hemiparesis in post-acute stroke patients, regardless of the types and locations of lesion after stroke, as well as the differences in comorbidities and medications.

Correlation between the ossification of nuchal ligament and clinical cervical disorders.

This is a correlation analysis between severity of the ossification of the nuchal ligament (ONL) and clinical cervical disorders including neck dysfunction, cervical malalignment, and morphologic changes of the cervical neural foramen (CNF). The clinical effects of ONL on active range of motion (AROM) of neck, cervical radiculopathy, abnormal cervical curvature, and the degree of CNF stenosis in patients with painful neck stiffness are investigated. Studies have investigated the predisposing factors to cervical dysfunction and degenerative disorders; however, few studies have examined the influence of the ONL on neck function and cervical spine. A total of 31 participants with painful neck stiffness were recruited. They accepted measurement of cervical AROM and serial cervical radiographs at anterior-posterior view, lateral view, and bilateral oblique views. Parameters of radiographs measurement included cervical lordotic curve, and cross-sectional areas (CSA) of the ONL and CNF (C2-C3, C4-C5, C5-C6, and C6-C7 levels). The ratio of CSA of the lower CNF (C4-C5, C5-C6, C6-C7) to CSA of the upper CNF (C2-C3) was used as a CNF stenosis ratio. The correlations of ONL size, neck symptoms, cervical AROM, lordotic curve, and CNF stenosis ratio were analyzed. More than half of all patients were positive in cervical root signs and prone to have larger ONL. Neck AROM of all participants was significantly below normal average in all directions, and a moderate negative association was found between the ONL CSA and AROM in flexion-extension. Most patients had moderate loss of cervical lordotic curve despite there being no significant correlation between ONL CSA and cervical curvature. Moreover, CNF stenosis ratio significantly negatively correlated with ONL CSA. Patients with larger ONL had more severe cervical radiculopathy, more stiffness in flexion-extension direction, more complex degenerative change of spine, and worse CNF stenosis.

Effects of a single session of whole body vibration on ankle plantarflexion spasticity and gait performance in patients with chronic stroke: a randomized controlled trial.

OBJECTIVE: To investigate the effects of a single session of whole body vibration training on ankle plantarflexion spasticity and gait performance in chronic stroke patients. DESIGN: Randomized controlled trial. SETTING: Rehabilitation unit in university hospital. PARTICIPANTS: Thirty subjects with chronic stroke were randomized into either a control group (n = 15) or a group receiving a single session of whole body vibration (n = 15). INTERVENTION: The intervention group was actually treated with whole body vibration while the control group was treated with placebo treatment. MAIN MEASURES: The spastic changes were measured clinically and neurophysiologically. Subjective evaluation of ankle spasticity was performed via a visual analogue scale. Gait performances were evaluated by the timed up and go test, 10-meter walk test and cadence. A forceplate was used for measuring foot pressure. RESULTS: The changes between whole body vibration and control groups were significantly different in Modified Ashworth Scale (1.33, 95% confidence interval (CI) = 1.06~1.60). The H (max)/M (max) ratio (0.14, 95% CI = 0.01~0.26) and visual analogue scale (1.87, 95% CI = 1.15~2.58) were significantly decreased. Whole body vibration could significantly improve gait velocity, timed up and go test (6.03, 95% CI = 3.17~8.89) and 10-meter walk test (1.99, 95% CI = 0.11~3.87). The uneven body weight posture on bilateral feet was also improved after vibration. CONCLUSION: These results suggest that a single session of whole body vibration training can reduce ankle plantarflexion spasticity in chronic stroke patients, thereby potentially increasing ambulatory capacity.

Preliminary study of exercise capacity in post-acute stroke survivors.

The purpose of this study was to evaluate the feasibility and exercise capacity of cycle ergometry exercise testing and exercise performance in patients with post-acute stroke. Nineteen male patients (mean age, 62.7 +/- 9.2 years) with a post stroke interval of 9.9 +/- 2.0 days underwent symptom- limited cardiopulmonary exercise testing. Peak exercise capacity was measured by open-circuit spirometry during standard upright ergometer cycling. The mean peak oxygen uptake was 11.8 mL/kg/min, peak heart rate with age-predicted maximal heart rate was 67.9 +/- 3.4%, and peak oxygen pulse was 7.5 mL/beat. The anaerobic threshold was achieved with a mean peak oxygen uptake of 73.4%. Mean peak minute ventilation was 42.1 L/min, and ventilatory reserve was 48.1 +/- 16.8%. Our findings confirm that cycle ergometry exercise testing is feasible and exercise capacity is compromised in post-acute stroke survivors within 2 weeks after stroke. Respiratory impairments do not appear to contribute to the reduced exercise capacity post stroke.

Oxygen uptake for cycling in relation to body composition: a pilot study.

The purpose of this study was to investigate the relationship between oxygen uptake (VO2) for cycle ergometry and body composition in untrained healthy young men. Fifty-six men underwent body composition measurements and ramp work rate tests at 60 revolutions/minute on a cycle ergometer. Cell mass (CM), fat mass (FM), lean body mass (LMB) and total body mass (TBM) were assessed by multifrequency and segmental bioelectric impedance analysis. Resting, unloaded, and peak VO2 were determined by a gas analyzer, and their relationships with CM, FM, LBM, and TBM were analyzed. Values of VO2/TBM were positively related to the increasing CM/TBM ratios (p < 0.05-0.01). However, VO2/CM did not change with anthropometric characteristics (p > 0.05). Resting, unloaded and peak VO2 were more strongly related to CM (p < 0.005-0.001) than to FM, LBM or TBM. Our findings revealed that FM, LBM and TBM least affected the relationship between VO2 and CM. These data suggest that CM actually provides the preferred frame of reference for estimating the VO2 for cycle ergometry at 60 revolutions/minute in untrained healthy young men.

Effects of different stretching techniques on the outcomes of isokinetic exercise in patients with knee osteoarthritis.

We recruited 132 subjects with bilateral knee osteoarthritis (Altman Grade II) to compare the effects of different stretching techniques on the outcomes of isokinetic muscle strengthening exercises. Patients were randomly divided into four groups (I-IV). The patients in Group I received isokinetic muscular strengthening exercises, Group II received bilateral knee static stretching and isokinetic exercises, Group III received proprioceptive neuromuscular facilitation (PNF) stretching and isokinetic exercises, and Group IV acted as controls. Outcomes were measured by changes in Lequesne's index, range of knee motion, visual analog pain scale, and peak muscle torques during knee flexion and extension. Patients in all the treated groups experienced significant reductions in knee pain and disability, and increased peak muscle torques after treatment and at follow-up. However, only patients in Groups II and III had significant improvements in range of motion and muscle strength gain during 60 degrees/second angular velocity peak torques. Group III demonstrated the greatest increase in muscle strength gain during 180 degrees/second angular velocity peak torques. In conclusion, stretching therapy could increase the effectiveness of isokinetic exercise in terms of functional improvement in patients with knee osteoarthritis. PNF techniques were more effective than static stretching.

The application of infrared thermography in the assessment of patients with coccygodynia before and after manual therapy combined with diathermy.

OBJECTIVE: This study examines the potential usefulness of a novel thermal imaging technique in the assessment of local physiologic responses before and after conservative therapies for coccygodynia. METHODS: Patients with coccygodynia were selected on the basis of detailed history taking, clinical examination, and dynamic series radiography. They underwent therapeutic modalities consisting of 6 to 8 sessions of manual medicine treatments (massage of the levators followed by Maigne's manipulative technique) and external physiotherapy (short-wave diathermy) 3 times a week for 8 weeks. We performed the assessments with numeric pain rating scale (NPRS) and infrared thermography (IRT) before treatment and at 12 weeks. RESULTS: A total of 53 patients (6 males and 47 females) ranging from 18 to 71 years of age and clinically diagnosed with coccygodynia received the full course of therapy and assessments. There were significant differences in both NPRS and surface temperature obtained by IRT in the 12-week follow-up (P < .05). The correlation between NPRS improvement and temperature decrement was significantly high (r = 0.67, P < .01). CONCLUSIONS: The study shows that IRT can objectively show the decrement of surface temperatures correlating with changes in subjective pain intensity after treatment of coccygodynia. With the advantages of being painless, noninvasive, and easy to repeat, IRT appears to be useful as a quantifiable tool for monitoring the dynamics of the disease activity in coccygodynia.

Association of C-reactive protein and insulin resistance in patients with chronic spinal cord injury.

OBJECTIVE: To study the association between C-reactive protein levels and insulin resistance in patients with spinal cord injury. DESIGN: Cross-sectional study. SUBJECTS: Forty-two subjects who had sustained spinal cord injuries at least 6 months before enrollment. METHODS: Circulating glucose, insulin and C-reactive protein levels were measured after 12 hours' fasting. The homeo-stasis model insulin resistance index was used to evaluate insulin resistance. Insulin resistance and C-reactive protein levels were compared between complete/incomplete patients and between paraplegic/tetraplegic patients. The subjects were then divided into 3 groups (C-reactive protein levels < 1, 1-3, > 3 mg/l) to compare insulin resistance. RESULTS: Eighteen (43%) subjects had C-reactive protein levels > 3 mg/l. The C-reactive protein levels and insulin resistance did not significantly differ between complete/incomplete or between paraplegic/tetraplegic subjects. However, insulin resistance in the high C-reactive protein group (>3 mg/l) differed significantly from that of the other 2 groups, and there was a significant correlation between C-reactive protein and insulin resistance, with r=0.7745. CONCLUSION: Most young and middle-aged patients with chronic spinal cord injury with high C-reactive protein levels also have high insulin resistance, and their C-reactive protein levels have well correlated with insulin resistance.

Effect of knee sleeve on static and dynamic balance in patients with knee osteoarthritis.

Patients with knee osteoarthritis (OA) find that use of elastic knee sleeves gives them partial pain relief and a greater sense of joint stability. However, the scientific effects of knee OA patients wearing braces are unclear. The purpose of this study was to investigate the effects of knee sleeves on static and dynamic balance in knee OA patients. Fifty patients with knee OA were enrolled in the study and all subjects were randomly divided into two groups. Initially, subjects in group A did not wear a neoprene sleeve while receiving balance tests but then wore them to be re-tested. Subjects in group B did just the reverse procedure. In this investigation, an instrument (KAT 2000; Breg Inc., Vista, CA, USA), which quantified motor control performance of the lower extremities was used and balance scores from the KAT 2000 software were obtained. The results revealed that the scores of patients wearing braces were significantly lower than those of patients without braces (p < 0.05).The finding of this study demonstrated that knee OA patients wearing knee sleeves could experience increased balance ability in both static and dynamic conditions. The improvement might prevent knee OA patients from falling down and increase their sense of security during physical activities.

Effects of functional electrical stimulation on peak torque and body composition in patients with incomplete spinal cord injury.

The aim of this study was to investigate the change in body composition, leg girths, and muscle strength of patients with incomplete spinal cord injury (SCI) after functional electrical stimulation cycling exercises (FESCE). Eighteen subjects with incomplete SCI were recruited. Each patient received FESCE three times per week for 8 weeks. Body composition, thigh and calf girths of bilateral legs, muscle strength of bilateral knee flexors and extensors were measured before and after 4 and 8 weeks of FESCE. A significant increase in bilateral thigh girth after 4 weeks of FESCE and significant increase in muscular peak torque of knee flexion and extension were found after 8 weeks of training. Besides, lean body mass increased significantly after complete treatment. FESCE can increase the thigh girth and muscular peak torque of patients with incomplete spinal cord injury.

Conversion disorder in stroke: a case report.

Conversion disorder is caused by previous severe stress, emotional conflict, or an associated psychiatric disorder, and usually presents with one or more neurologic symptoms. Clinically, it is challenging to diagnose diseases such as transient ischemia attack, stroke, brain tumor, spinal cord injury, and neuropathy. In this case report, we present a male stroke patient who had a typical conversion disorder.